Organization
EVERGREEN BEHAVIORAL MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GINGER G GORE (OWNER)
(910) 640-5512
Entity
Organization
Contact information
Practice address
220 G & H WINTERGREEN DR, LUMBERTON, NC 28358
(910) 738-9420
(910) 671-9414
Mailing address
PO BOX 425, WHITEVILLE, NC 28472-0425
(910) 640-5512
(910) 641-0606
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300536
—
NC
Enumeration date
02/05/2009
Last updated
03/13/2009
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